[16.2] Psychological Therapies

Question 1

Insight Therapies

Answer 1

• insight therapies: a general term referring to therapy that involves dialogue between client and therapist for the purposes of gaining awareness and understanding of psychological problems and conflicts
• psychodynamic therapies: forms of insight therapy that emphasize the need to discover and resolve unconscious conflicts

Question 2

Psychoanalysis: Exploring the Unconsciousness

Answer 2

• psychoanalysis sprung out of Freud’s understanding of consciousness
• Freud and his associates came up with several methods they believed would help them access the mysterious unconscious realm:

1. uring the practice of free association, clients are encouraged to talk or write without censoring their thoughts in any way, allowing everything that pops into the mind to come spilling out, no matter how odd or meaningless it may seem
   
   • Freud believed that this uncensored thought barrage would reveal clues to aspects of the unconscious that clients normally wouldn’t allow to be expressed
2. dream analysis: a method for understanding the unconscious by examining the details of what happens during a dream (the manifest content), in order to gain insight into the true meaning of the dream, the emotional, unconscious material that is communicated symbolically (the latent content)
3. resistance: occurs as the treatment brings up unconscious material that the client wishes to avoid, and the client engages in strategies for keeping the information out of conscious awareness
   
   • may be subtle, such as the client using humour to avoid talking about something painful, or it may be obvious, such as the client skipping sessions, becoming angry at the therapist, or becoming cynical about the whole process
   • ironically, this is considered a promising signal for the psychoanalyst because it means that they are beginning to access the unconscious motives of clients’ present difficulties; psychoanalysts then attempt to push through the resistance by making clients aware of how and what they are resisting
4. transference: a psychoanalytic process whereby clients direct the emotional experiences that they are reliving toward the therapist, rather than the original person involved in the experiences (e.g. their parents)
   
   • once it is reached, the therapist and client can begin to work through specific problems and discuss ways of coping with them

Question 3

Modern Psychodynamic Treatments

Answer 3

• today, Freudian-based psychoanalysis is practiced by a relatively small number of therapists
• object relations therapy: a variation of psychodynamic therapy that focuses on how early childhood experiences and emotional attachments influence later psychological functioning
• in contrast to psychoanalysis, object relations therapy does not centre on repressed sexual and aggressive conflicts; the focus is on “objects,” which are the clients’ mental representations of themselves and others
• a strong emphasis on interpersonal relationships informed Harry Stack Sullivan’s interpersonal psychotherapy
• in this approach, the therapist assumes the role of participant observer, through which the therapist both interacts with and observes the client over time in order to understand any unrealistic expectations the client may have toward their relationships as well as other situations in daily life.

Question 4

Humanistic-Existential Psychotherapy

Answer 4

• in the 1950s, when humanistic psychologists broke from psychoanalytic approaches, creating a new discipline based on at least five fundamental differences (table 16.2)
• therapies operating within this orientation emphasize individual strengths and the potential for growth, as well as the belief that human nature is essentially positive, rather than the essentially negative perspective advanced by psychoanalytic approaches
• rather than interpreting the hidden meanings of dreams and free associations, the therapist’s role is to listen empathically in order to understand the clients’ internal world
• this is referred to as a phenomenological approach: the therapist addresses the clients’ feelings and thoughts as they unfold in the present moment, rather than looking for unconscious motives or dwelling in the past
• Carl Rogers developed a version of humanistic therapy called clientcentred therapy (or person-centred therapy), which focuses on individuals’ abilities to solve their own problems and reach their full potential with the encouragement of the therapist
• Rogers believed that all individuals could develop and reach their full potential
• people experience psychological problems when others impose conditions of worth, meaning that they appear to judge or lose aff ection for a person who does not live up to expectations
• if people give the impression that their respect and love for a person are contingent upon the person behaving in certain ways or meeting certain expectations, then they have imposed conditions of worth
• conditions of worth can produce longterm consequences to psychological health because they increase insecurities within the individual; as a result, the individual is likely to change his behaviour in an attempt to regain affection

Question 5

Evaluating Insight Therapies

Answer 5

• the effectiveness of insight therapies depends on the condition being treated
• studies that have used the most rigorous research designs have shown that psychodynamic therapy has not been effective in treating severe depression or schizophrenia, but it has shown promise for treating panic disorder, dependence on opiate drugs (e.g. heroin), and borderline personality disorder
• a strong alliance is a good predictor of successful therapy over and above the specific type of therapy delivered
• in general, it is more effective than no treatment at all
• however, some studies have found it to be no more effective than a placebo treatment, whereas others have found it to be as effective as cognitive behavioural therapy

Question 6

Behavioural Therapy

Answer 6

• behavioural therapies: address problem behaviours, and the environmental factors that trigger them, as directly as possible
• patterns of behaviour are the result of conditioning and learning that have led to the automatization of maladaptive habits
• systematic desensitization: the behevioural technique in which gradual exposure to a feared stimulus or situation is coupled with relaxation training
• in some cases, the client may elect to undergo a process called flooding: goes straight to the most challenging part of the hierarchy, exposing himself to the scenario that causes the most anxiety and panic
• another technique is based on observational learning or modelling: the client observes another person engage with the feared object or situation.

Question 7

Virtual Reality Therapy

Answer 7

• virtual reality exposure (VRE): a treatment that uses graphical displays to create an experience in which the client seems to be immersed in an actual environment
• the much more vivid environment maps on more easily to the real thing, and shows promise for helping people learn to relax in the face of their fears
• virtual reality therapy may help to reduce the tendency for people’s avoidance strategies
• over the past decade, this technology has become increasingly common in helping soldiers returning from the military conflicts in Iraq and Afghanistan—many of whom have developed PTSD

Question 8

Aversive Conditioning

Answer 8

• aversive conditioning: a behavioural technique that involves replacing a positive response to a stimulus with a negative response, typically by using punishment
• aversive conditioning is a behavioural technique that involves replacing a positive response to a stimulus with a negative response, typically by using punishment
• requires willpower and motivation to take the drug everyday knowing that it will make you sick

Question 9

Cognitive-Behavioural Therapies

Answer 9

• behavioural therapies, despite their eff ectiveness at changing problem behaviours, do not directly address problematic thoughts
• cognitive-behavioural therapy (CBT): a form of therapy that consists of procedures such as cognitive restructuring, stress inoculation training, and exposing people to experiences they may have a tendency to avoid
• CBT therapists help clients become more aware of the thought, emotion, and behaviour patterns that arise in their current lives; through this heightened self-awareness, clients learn to identify their habitual dysfunctional tendencies, and then work on building more functional cognitive and behavioural habits
• at the behavioural end of CBT, clients are given exercises and guidance in gaining skills they may be lacking
• at the cognitive end of CBT, clients are given exercises and strategies to build more functional cognitive habits
• cognitive restructuring involves learning to challenge their negative thought patterns, to question their self-defeating beliefs, and to view situations in a different light
• negative explanatory style: is the tendency to make internal, stable, and global attributions for negative events
• internal attributions: the thoughts that say “it’s all my fault”; blaming oneself excessively for negative things that happen, rather than appreciating that, even though one may bear some responsibility, there were also other factors that contributed to the negative event, such as bad luck or the behaviour of other people
• stable attributions: are thoughts like “it’s never going to change”; coming to see the situation as permanent and irreversible
• global events: thoughts like “my whole life is ruined”; blowing things out of proportion rather than seeing a negative event as simply that, one negative event and not something that needs to spiral into greater problems

Question 10

Mindfulness-Based Cognitive Therapy

Answer 10

• the integration of meditation-based practices, such as mindfulness, with traditional cognitive-behavioural approaches
• the goals are to reap the benefits of mindfulness and then to work on changing dysfunctional patterns using CBT
• traditional Eastern meditation and spiritual practices merge with Western psychological therapies and neuroscientific understanding
• mindfulness is like re-parenting yourself; it’s an opportunity to rebuild yourself, actually changing your own biological structures that are involved in emotional security
• a second key way in which mindfulness affects a person is through the experience of decentring: occurs when one is able to “step back” from one’s normal consciousness and observe oneself more objectively
• beneficial for social anxiety disorder and generalized anxiety, bipolar disorder, depression, hypochondriasis, and suicidal ideation
• in CBT, clients practise replacing their dysfunctional thoughts with more functional thoughts; whereas in mindfulness practice, clients simply watch their thoughts and accept them as they are

Question 11

Group and Family Therapies

Answer 11

• in some situations, clients may benefit by participating in group therapy sessions
• the bonding and support that occur in this context can be very powerful
• in other situations, psychologists may conduct family therapy; may occur if a client’s difficulties stem from or are reinforced by unhealthy dynamics within the family
• family therapists generally take a systems approach: an orientation that encourages therapists to see an individual’s symptoms as being influenced by many different interacting systems

Question 12

Evaluating Cognitive-Behavioural Therapy

Answer 12

• behavioural therapies have been shown to be particularly effective at treating symptoms associated with anxiety disorders, such as obsessive-compulsive disorder and specific phobias
• have also proved useful for increasing behavioural skills (e.g. social skills) and decreasing problematic behaviours (e.g. social withdrawal)
• cognitive-behavioural therapy has been quite effective in treating depression
• have also been successful in treating such conditions as anxiety, obesity, and eating disorders
• CBT is the most eff ective treatment currently available for anxiety disorders